Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality

Abstract

Introduction and objectives: The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. Methods: This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. Results: Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values 5 showed high specificity (100%) but low sensitivity. Conclusions: A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis. Introduccio´n y objetivos: El prono´ stico de la estenosis ao´ rtica (EAo) grave asintoma´tica en la poblacio´n anciana, que a menudo asocia fragilidad y comorbilidades no ha sido estudiado. Se propuso analizar que´ factores podr¿´an influir en la mortalidad precoz esta poblacio´n. Me´todos: Estudio ambispectivo de cohortes en 104 pacientes con edad 70 an¿os y EAo grave asintoma´tica. Se recogieron variables epidemiolo´ gicas, geria´tricas, cl¿´nicas y ecocardiogra´ficas y se compararon entre pacientes fra´giles y no fra´giles. Durante el seguimiento se recogio´ el tiempo desde el diagno´ stico hasta la mortalidad. Resultados: El 59,6% de los pacientes eran fra´giles. El 69,4% de los pacientes fra´giles fallecieron, con una mediana de supervivencia de 2,52 an¿os (IC95%, 1,36-3,69). La tasa de supervivencia global al an¿o en estos sujetos fue del 76%. En el ana´lisis multivariante la edad (HR = 2,47; IC95%, 1,00-6,12), el ¿´ndice de Charlson 5 (HR = 3,75; IC95%, 1,47-9,52) y la fragilidad (HR = 6,67; IC95%, 1,43-9,52) se asociaron independientemente a la mortalidad. Un 8,7% de los pacientes presentaron un ¿´ndice de Charlson 5 y tuvieron una mediana de supervivencia de 1,01 an¿os (IC95%, 0,36-1,67). El a´ rea bajo la curva receiver operating characteristic del ¿´ndice de Charlson fue 0,739 (IC95%, 0,646-0,832). Los valores 5 mostraron una elevada especificidad (100%) pero baja sensibilidad